各种辅助检查对肝豆状核变性的诊断价值

目的探讨各种辅助检查对肝豆状核变性(HLD)的诊断价值。方法对200例确诊HLD患者的临床表现及主要辅助检查资料进行分析。结果本组患者发病年龄2~46岁,平均(17±8·6)岁;最常见的临床表现为震颤(42.5%);以脑型(122例,61%)患者最多;尿铜检查169例,均≥100μg/24h;铜蓝蛋白检查194例,均<0·15g/L,其中178例≤0·08g/L;血清铜检查84例,68例≤0·6mg/L,10例为(0·61~0·9)mg/L,6例>0·9mg/L;角膜K-F环检出率为85·5%;脑型患者肝功能异常率低于肝型患者;各型HLD患者肝脏B超均有特殊改变;头颅MRI检查79例,65例异常,病变对称,主要集中在基底节区。结论血清铜蓝蛋白是HLD最有价值的辅助检查,当其≤0·08g/L时具有独立的诊断价值;角膜K-F环对具有神经、精神症状的HLD患者具有很大的诊断价值;24h尿铜是最好的单个筛查指标,它在具有症状的HLD患者中全部升高;腹部B超、头颅MRI等影像学检查虽不能作为HLD的诊断依据,但对肝、脑的损害有提示作用。     

骨髓转移癌的骨髓象诊断及临床分析

目的 探讨临床表现及骨髓象改变在骨髓转移癌患者诊断中的意义。方法 对41例骨髓转移癌患者的临床资料及骨髓象进行分析，观察主要临床改变。结果 所有病例均在髓片可找到多少不等的成团、成簇的转移癌细胞，且形态学可见明显异常改变。结论 对明确诊断为恶性肿瘤的患者常规骨髓穿刺涂片可早期发现骨髓转移，多部位或多次穿刺涂片可提高阳性发现率。     

Development of phantom for radiographic image optimization of standard patient in the lateral view of chest and skull examination

We present the construction of a homogeneous phantom to be used in simulating the scattering and absorption of X-rays by a standard patient chest and skull when irradiated laterally. This phantom consisted of lucite and aluminium plates with their thickness determined by a tomographic exploratory method applied to the anthropomorphic phantom. Using this phantom, an optimized radiographic technique was established for chest and skull of standard sized patient in lateral view. Images generated with this optimized technique demonstrated improved image quality and reduced radiation doses.     

17例无绳胶囊内镜检查临床分析

目的通过对无绳胶囊内镜检查情况分析，评价胶囊内镜检查在临床上应用的效果。方法对17例疑小肠疾病或不能耐受胃镜检查的病人或体检者行胶囊内镜检查，并对其结果进行分析。结果所有病人检查无不适感，15例完成小肠检查，2例胶囊分别滞留于食管、胃。7例不明原因胃肠道出血中5例完成小肠检查。均发现了小肠病变。结论胶囊内镜检查是一种无痛苦、无创、安全的上消化道检查，是小肠疾病尤其是不明原因胃肠道出血诊断的首选方法。     

Risk factors of type 2 diabetes among Korean adults: The 2001 Korean national health and nutrition examination survey

This study aimed to identify risk factors for type 2 diabetes (T2D) in Korea, a rapidly changing country. Data of 5,132 adults aged 20-85 were used from the 2001 Korean Health and Nutrition Examination Survey. Multiple logistic regression was carried out to identify risk factors for T2D. Three models were specified: (i) socioeconomic and demographic factors (model 1: age, gender, education, poverty income ratio, employment), (ii) behavioral risk factors and covariates (model 2: obesity, physical activity, smoking, alcohol drinking, dietary quality, family history of T2D, co-morbidity) and (iii) socioeconomic, demographic, and behavioral factors (model 3). The prevalence of T2D was 7.4%. Less education (OR 1.41, 95% CI 1.08-1.84), age (OR 2.19, 95% CI 1.56-3.08 in 40-59 yrs, OR 4.05, 95% CI 2.76-5.95 in 60 yrs + comparing to 20-39 yrs) and abdominal obesity (OR 2.24, 95% CI 1.79-2.82) were risk factors for T2D even after controlling for other factors simultaneously. There was a significant association of T2D with ever smoking (OR 1.34, 95% CI 1.06-1.67). The relationship of age with T2D was modified by gender in model 1 and the relationship of smoking with T2D was modified by obesity in model 2. Less educated, older, obese or ever smokers were more likely to have T2D. Gender mediated the relationship of age, and obesity mediated the relationship of smoking, with T2D. Intervention programs for T2D in Korea should take the interactions among risk factors into account.     

The Colorado Haemophilia Paediatric Joint Physical Examination Scale: normal values and interrater reliability

Persons with haemophilia often experience their first joint haemorrhage in early childhood. Recurrent bleeding into a joint may lead to significant morbidity, specifically haemophilic arthropathy. Early identification of the onset and progression of joint damage is critical to preserving joint structure and function. Physical examination is the most feasible approach to monitor joint health. Our group developed the Colorado Haemophilia Paediatric Joint Physical Examination Scale to identify earlier signs of joint degeneration and incorporate developmentally appropriate tasks for assessing joint function in young children. This study's objectives were to establish normal ranges for this scale and assess interrater reliability. The ankles, knees and elbows of 72 healthy boys aged 1 through 7 years were evaluated by a physical therapist to establish normal ranges. Exactly 10 boys in each age category from 2 to 7 years were evaluated by a second physical therapist to determine interrater reliability. The original scale was modified to account for the finding that mild angulation in the weight-bearing joints is developmentally normal. The interrater reliability of the scale ranged from fair to good, underscoring the need for physical therapists to have specific training in the orthopaedic assessment of very young children and the measurement error inherent in the goniometer. Modifications to axial alignment scoring will allow the scale to distinguish healthy joints from those suffering frequent haemarthroses.     

Evaluating anxiety in patients attending optometric practice

Although anxiety is a well-established obstacle to the delivery of effective health care, there have been no attempts to measure it in the optometric consulting room. In this paper, we introduce physiological and psychological techniques that may be used to evaluate anxiety and arousal in the consulting room and present data from a small group of patients attending for a routine eye examination. Specifically, arousal was assessed before, during, and after the examination by measuring skin conductance in five patients. Anxiety was evaluated using the State-Trait Anxiety Inventory. Our data confirm the ability of these techniques to quantify arousal and anxiety in the optometric consulting room and reveal a previously unknown but important facet of the eye examination. We conclude that these techniques are suitable for use in further experimental work and may be used to identify factors capable of reducing anxiety in the optometric consulting room.     

佛山市城区集体儿童健康状况调查分析

目的了解佛山市城区集体儿童健康状况,以制定干预措施。方法采用随机整群抽样的方法,抽取本市城区共15间幼儿园,并对各间园所的儿童体检的资料数据进行整理和分析。结果佛山市集体儿童缺点总检出率为71.40%。其中私营幼儿园儿童缺点患病率明显高于事业单位的幼儿园(P<0.05),有显著性差异。儿童骨矿物质测定缺钙的检出率为13.73%。男女儿童无性别差异。结论今后继续加强对幼儿园的管理工作,私营的幼儿园管理工作是我们今后管理工作的重点,做好防治工作,降低患病率,增强儿童的身心健康。     

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目的 探讨影像学检查(image examination，IE)对闭合性腹部损伤(closed abdominal injuries，CAI)的诊断价值。方法 1997—2003年间对142例血流动力学稳定的闭合性腹部损伤病人行影像学检查，结合术中所见，分析比较IE的准确性和差异。结果 IE阳性112例病人中，104例经剖腹探查术证实有腹腔脏器损伤，8例假阳性；30例IE阴性病人，真阴性19例，假阴性11例；敏感性为90．4％，特异性为70．4％，准确性为86．7％。结论 IE具有早期诊断价值，IE阳性对判断腹腔内实质性脏器损伤的特异性最高，IE阴性，需行进一步检查排除其他隐匿性损伤；结合临床表现及其他辅助检查综合分析，准确性会更高。     

胃壁内迷走胰腺的X线征象

目的提高对胃壁内迷走胰腺的认识。方法回顾性分析4例手术病理证实的胃壁内迷走胰腺的临床和钡餐检查X线表现。结果4例胃壁内迷走胰腺均发生在胃窦部近幽门区大弯侧,钡餐表现为轮廓较光滑的圆形或卵圆形充盈缺损,直径1～4cm,形态、位置固定,不随胃蠕动或触压而改变;临近黏膜可规整或粗乱,其中,典型的"脐样"征1例。结论主要X线征象为位于胃窦部幽门区大弯侧边缘光滑、位置固定、无溃疡的充盈缺损,难与息肉或平滑肌瘤或间质瘤等鉴别。